Lawmakers Introduce Bipartisan Bill To Reform Medicare Advantage

A bipartisan group of lawmakers has introduced a bill that would tighten oversight of Medicare Advantage plans, whose low reimbursement rates have added margin pressure for home health care providers.

The bill, called the Medicare Advantage Improvement Act of 2026, would hasten prior authorizations, increase transparency, align coverage criteria with traditional Medicare and expand access to post-acute care providers, among other provisions. 

“Medicare is a promise to America’s seniors that they will have dependable access to quality healthcare in their later years. However, that promise has been undermined by unnecessary barriers to care – particularly through excessive use of prior authorization and inappropriate coverage denials in Medicare Advantage,” Rep. John Joyce, who is among the lawmakers introducing the bill, said in a statement. “The Medicare Advantage Improvement Act will restore accountability, reduce unnecessary barriers and ensure that seniors receive timely, high-quality care.”

The bill, introduced on Wednesday, requires that Medicare Advantage plans cannot use stricter criteria than traditional, fee-for-service Medicare.

It includes several provisions related to prior authorizations. If passed, it would require Medicare Advantage plans to respond to standard prior authorization requests within 72 hours and to expedited requests within 24 hours. The bill grants limited extensions in specific circumstances. It places limits on prior authorization use as well, disallowing plans from implementing prior authorizations when a service is already approved or when a clinician makes clinically necessary changes.

It also requires plans to implement real-time approval systems, publicly report several data points and disallows plans from denying payment after a service is authorized.

The bill also creates a new compliance scoring system, and would implement payment cuts for low-performing plans.

The lawmakers introducing the bill are U.S. Reps. John Joyce (R-Pa.), Greg Murphy (R-N.C.), Jimmy Panetta (D-Calif.), Ami Bera (D-Calif.), Beth Van Duyne (R-Texas), Kim Schrier (D-Wash.) and Mariannette Miller-Meeks (R-Iowa).

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